In a post done in 2009 that’s still getting comments, Diane G. offered some interesting commentary that I think is fair warning for those purchasing an EHR (names removed since it could apply to a lot of EHR vendors):

We use Software A for our EMR, but Company A provided the equipment and installation quote for Software A and I can tell you, you’ll want to look at EVERY line they bill to your company. We have been billed for equipment that we never received and interfacing that was never launched. I have spent hours explaining to them what services they have billed us but didn’t provide. I am extremely grateful that we did not purchase their EMR and/or Practice Management product!!

Definitely a good warning for all purchases, but applies to EMR software as well. A number of EHR software companies have really simplified the way they bill and so this is less of a problem with those EHR vendors. However, many EHR vendors still try to pilfer doctors for the extras which can often add up to more than the core product. It’s ugly and unfortunate since it leaves a bad taste in doctors mouths.

Along these same lines is making sure your EHR contract is sound. There’s a whole section on EHR contracts in my EHR Selection e-Book that is worth looking at if you’re going through the EHR process.

Curt Rosinski offered some really good advice on a previous meaningful use post for those doctors who are evaluating EHR software and the customization features that they offer:

The thing all potential consumers should keep in mind when buying an EHR, EMR or any medical management software is this; the more out-of-the-box the product is, the less customization the product is capable of. Customization in this case being meaningful customization, not screen color or placement of toolbar.

I’m not sure I agree completely that the more out-of-the box the product is, the less customization will be available. This could be the case, but EHR vendors can make it so you can customize everything in the EHR while still preserving a great out-of-the-box EHR experience.

However, the second comment was even more interesting to me. I’m always amazed how some people evaluating an EHR get so annoyed by the color of a window or get so enamored by the size of the font. I’m not saying that the color of the window and size of the font aren’t important. They can be really important in improving the usability of the software. However, if those things are so important to the usability of the system, then they shouldn’t likely make those things part of the customization preference package.

The idea of meaningful EHR customizations is a good one. Look for the EHR that does a great job balancing the out-of-the box EHR implementation experience while still making lots of customizations possible, because you can be sure that 6 months into your EMR implementation you’ll be ready to look at ways to really maximize the use of your EHR.

I imagine that many of you have seen some people talking about HITR around the web. It’s a website backed by the people at Porter Research and Billian’s HealthData. I know that I first saw it a few months ago and wasn’t quite sure I understood what they were trying to do. I couldn’t tell if they were trying to be Sermo, a private healthcare IT social network, or something new. The lack of clear vision for me meant I set it to the side.

While attending AHIMA this year I had the chance to spend quite a bit of time with a number of different people from Billian’s HealthData and Porter Research. We had a great time talking about all sorts of things, but they of course told me that I should look more at their new HITR product. I told them I’d take a look not knowing what to really expect.

A week or so ago, Jennifer Dennard set up a demo of HITR for me. While still a nascent product, I was intrigued how they used their knowledge and experience in healthcare research and embedded it so fully in the product. I guess I could have and should have assumed as much, but I was reasonably impressed with the idea of having a hub for healthcare IT research. I know how much I and other IT people love our data.

One interesting thing about HITR is the give to get model that they’ve set up. Basically they’ve arranged it so you give your feedback on your products to get access to other information and research from your peers. I imagine they’ll be adjusting this model over time, but it kind of reminds me of the open source model where everyone contributes a little bit and everyone benefits from the other people’s efforts.

The real challenge that HITR faces is just making sure they get enough people involved and participating to make the information they collect valuable. Plus, they have to get enough people and the right people on board. I’m not sure how scientific the results will be considering it’s a basically self selected example. I can’t remember if they include qualitative results along with the quantitative, but that could be really helpful even if the results aren’t scientifically correct on the quantitative side.

One other concept that they said they were exploring with HITR is the idea of getting connected with referral sites for a healthcare IT product that you’re considering. I REALLY love this idea. In my e-Book on EMR selection I recommend finding some referral sites and visiting them to get a feel for that EHR software in practice and to talk with a doctor who actually uses that EHR software day in and day out. The problem is that if you ask the EMR company for some referral sites they’ll give you a bias list. I suggest in the book to ask for their entire client list. However, I think using HITR could be another interesting way to find a referral site outside of the EMR vendors’ pre-groomed list.

I asked Jennifer Dennard to send me a list of some of the other benefits of using HITR. This should also give you a decent feel for what they’re working on with HITR.

I’d list the benefits for everyone as:

• Ability to connect with peers
• Blogs
• Groups
• Discussions
• Job boards

Benefits to providers that take surveys would include:

• Ability to gauge how your employees evaluate the systems you’ve put in place at your facilities
• Ability to see how those same systems are rated by your colleagues at peer institutions
• Ability to start a more in-depth dialogue with HITR connections about HIT systems you may be considering for your facility, and their experiences with those same systems
• Ability to influence future HIT product development

Benefits to vendors include:

• Ability to view how their systems are evaluated by their customers
• Ability to correspond with providers for product management/development purposes
• In the near future, vendors will be able to sponsor surveys through HITR to deploy to their chosen audiences – customers, prospects, etc.

If you have a chance to sign up for HITR, I’d love to hear your thoughts and experience. Like I said, it’s a new site, but has some interesting possibilities if they execute it right.

I’m really excited that this Common EHR implementation issues series has been so popular. If you missed it, you can see the previous posts in the series: Unexpected EHR Expenses, EHR Performance Issues, a little follow up to avoiding the EHR performance issues altogether, and inadequate EHR templates.

This weeks common EHR implementation issue is: EMR Upgrade Problems

I’d like to categorize this EHR implementation issue into two areas. One is upgrading to an EHR from an old legacy EHR and/or PMS. The second is upgrading your existing EHR that’s just outdated. I’ll take them in reverse order.

Upgrade of Existing Outdated EHR
In this world of your web browser and operating system auto updating at regular intervals it’s sometimes hard to remember that not all software does that. In fact, it turns out that most software doesn’t auto update (often for good reason). Of course, this problem doesn’t apply to a SaaS based EHR software since those updates are applied whether you like it or not. The nice part is that the SaaS EHR updates appear to the user to just happen automatically with little to no intervention on their part. Of course, we’ll save what happens when a SaaS EHR update causes you problems for another post. In the client server world of EHR (or hybrid EHR as some like to call themselves when they’re web based on an in house server) you will have to deal with updating your EHR.

I think with rare exception, it’s a huge mistake to not keep your EHR software up to date (goes for most other software as well). I’m not suggesting that even client server software should auto update. Considering the deployment and upgrade model of most EHR software, it’s almost essential to review the new feature list before doing an update to ensure that the update won’t cause you unnecessary heartache. Understanding the changes that will happen with the EHR Upgrade will let you warn your users about it so that they don’t come running into your office after the upgrade wondering why their favorite feature was changed.

What’s the problem with not upgrading? Many might just think that they don’t need to update their EHR software since they don’t want/need the extra features that are part of the upgrade. This is a bad strategy for a couple reasons. First, there are often security fixes that are part of the EHR upgrade that you’ll be missing out on if you don’t upgrade. Second, a bunch of relatively minor updates is much better on a clinic than one massive one that requires a ton of change. Third, when a future update comes that has a feature you do want, it’s not always pretty to go through multiple upgrades at the same time. Fourth, try calling the EHR support when you’re on an old version. Most of the time they’re going to say you need to upgrade for them to appropriately support you.

One other suggestion on EMR Upgrades now that I’ve supported the idea of upgrading. Just because I suggest you upgrade to the latest version of your EHR, doesn’t mean you have to be the beta tester for the company. Do the upgrade early in the process, but not necessarily so early that you’re going to be the bug tester for the company.

Upgrading an EHR from a Legacy EHR or PMS
This situation happens most often when either a clinic decides to switch from their old hasn’t been updated legacy PMS (which might include some basic EHR features) or when a clinic decides to move off their existing EHR to a new one.

Upgrading from a legacy PMS could easily be a whole series of blog posts. Suffice it to say that the biggest challenge with the upgrade from the old legacy PMS system is often getting the data out of it. Some legacy PMS systems don’t provide that data willing. In fact, many will even charge you to get access to it. They’ve basically lost you as a customers, so they’re trying to maximize whatever revenue they can get. It’s not pretty.

Even if you can get access to the data, there’s often a lot of data manipulation that will have to occur. A common problem that’s related to this is whether you even want to get the data out of the old PMS. Far too often, the data in the old legacy system has so much junk in it, that it’s worth considering the option of starting from scratch. It’s not pretty to upload inconsistent and ugly data from a legacy system into your nice, new EHR software.

Switching from one EHR software to another is becoming more and more common. In 2-3 years I believe we’re going to see an amazing influx of EHR software switches. It will be the topic du jour. We’re already starting to see it in a number of situations: an EHR that isn’t certified, an EHR that the doctor hates, an EHR that’s gone under, an EHR that’s sold to another company, etc.

The biggest problem right now with switching EHR software is that there’s no standard for the data to be exported and imported into a new EHR company. Some of you might remember my post asking EHR vendors to consider the value of EHR data liberation. In it I describe why not only is it the right ethical thing to do, but it also can make a lot of business sense to do so. Sadly, I’ve only really seen one EHR software that has embraced the concept of really liberating the data in their EHR.

I’d love to support a movement from EHR vendors that embrace the concept of EMR data liberation. I imagine most are too afraid of giving their users an easy option to leave their EHR. It’s too bad EHR vendors are so focused on protecting their business instead of focusing everything they do on the customer experience, but I digress.

Considering the above described state of EHR data export, you can see why moving to an EHR is such an issue. It’s worth mentioning this topic before you even select an EHR. Before purchasing the EHR, ask the question, What if this EHR is terrible and I want to switch? This is water under a bridge if you’re already in a compromising position under contract with an EHR you don’t like.

Unfortunately, I don’t really have very many great suggestions for those in this position. Just some words of comfort. First, switching EHR software can actually be easier than implementing an EHR in the first place. You already have the computers and IT infrastructure. Plus, for some reason second EHR implementations have a much higher success and satisfaction rate from what I’ve seen. Second, while it’s a bitter bullet to bite, everyone that I know that’s done it wishes they’d done it earlier. Although, don’t rush into another EHR just because. Take your time to select an EHR properly if you’re going to switch, but don’t be afraid to switch based on what economists call sunk costs. Third, this is one case where it’s often good to hire someone who’s done these type of EHR switching before. They can be a big help.

Dr. James Coffin, VP of Healthcare and Life Sciences at Dell, has a post up on the Dell Healthcare Community site that looks at the stances of the various Republican candidates for the US Presidential nomination. It’s an interesting read if you haven’t been following the republican candidates very much.

What the article doesn’t address is these candidates stance on the HITECH Act. The key here is to realize that the HITECH act isn’t part of the Affordable Care Act which every GOP candidate is saying they will repeal if they become President. So, where does that really leave the HITECH Act should a republican president be elected?

The problem is that no one really knows. Those who argue that the HITECH Act is safe often lean on the ideas that EMR and EHR has always had bipartisan support. Many often mention that the push for adoption of EHR software was started by a republican president, George W. Bush. I actually agree that both sides of the aisle want to have widespread adoption of EHR. We could certainly argue the benefits or detriments of EHR adoption, but for a relatively uninformed senate, house and president when it comes to EHR, they’re going to easily grab on to the idea that technology can improve healthcare. We may agree or disagree with this point, but I think we’d be hard pressed to find a senator that thinks we shouldn’t have EHR technology in healthcare.

The problem with the above discussion has to do with the way that EHR is being paid for. Again, this isn’t about whether the idea of paying doctors to use EHR software is right or wrong, good or bad. This is more about the political stance of the republicans and how they want government to spend money. It seems very clear to me that Republicans are going to keep sitting on their no spending/cut spending soap box. If a republican becomes President, we’re likely to see widespread cuts. Could HITECH money be a casualty of those cuts? Absolutely. Will they be a casualty? Can anyone predict what Washington will really do?

Should doctors and practices then be afraid of going after the EHR stimulus money? Well, I’ve been advising doctors and practices for the last couple years to not implement an EHR in order to get the government hand out. Those that are doing EHR for “free” government money are going to be disappointed. Not only because the money could be cut, but because sooner or later that money will be gone. So, if you’ve followed my advice, then the loss of the EHR stimulus money will be unfortunate but not too terrible.

On the other hand, those people who only did EHR because the government was waving the carrot and the stick are likely going to be quite disappointed. Particularly if the practice focused on the governments EHR requirements instead of their own individual practice needs when it comes to an EHR. Sadly, I believe there are many clinics in this boat.

I’m sure there are other Washington DC insider workings that are in play as well. Hopefully many of you will share some of what you know in the comments.

Personally, I’m still fairly confident that the EHR stimulus money will play itself out. I’ll be a little surprised if indeed it does get cut. I think republicans will have larger fish to fry. However, there’s certainly that possibility, so doctors should take this into account when they’re selecting and implementing an EHR.

This was a great piece of advice that was given at my Health Tech Next Generation EMR 101 panel.
@2healthguru – Gregg Masters
We run from EMR vendors w/products that offer lots of free hours of training. Means EMR UI not Intuitive @brandrew0 #HTng11

I’d only clarify that unlimited free support is good, but it’s when they suggest you use a week of that free support that you run.

I can’t remember exactly where I saw someone talk about the “WIIFM” (What’s in it for Me) principle, but it really is an important principle that when understood can have an amazing impact for good. This post isn’t about whether you should live a life asking WIIFM. I’ll leave that question to people much smarter than me. Instead, I want to look at how applying the WIIFM principle to others can help those working on a successful EHR implementation.

In most cases I’m talking about, the WIIFM should be changed to “What’s in it for Them?” Understanding the answer to this question can help you as an EMR consultant, an EMR vendor or even a practice manager or doctor that’s trying to work through an EMR implementation.

One of the first things I cover in my e-Book on EMR selection (It’s free, check it out) is the idea of getting buy in from those that will be affected by the EHR implementation (that’s usually everyone). One of the best ways to get EHR buy in from people is to understand the WIIFM. It’s not fool proof, but it’s one good strategy for getting people on the same bus, going the same direction.

Let me tell you that there’s always a way to find a WIIFM in an EHR implementation. This list of EMR and EHR benefits is a great place to start. However, many of those benefits can be extrapolated in ways that will show what’s in it for every person in the clinic.

Let’s say for example, that your goal for implementing an EHR is to increase clinic revenue by freeing up chart storage space so you have an extra exam room for another provider. You can then talk about what that new revenue can be used for to improve the clinic. Maybe it could include bonus checks or other incentives. These become tangible things that staff can use to better understand WIIFM in an EHR implementation.

I’m sure many of the nay sayers out there are thinking, but an EHR doesn’t provide those benefits. That’s why it’s so important that you define which benefits your clinic is striving to achieve before you select or implement an EHR. The list of benefits you use to show WIIFM ends up being your goals for your EHR implementation. They can be used to define your EHR selection process. They can be included in the EHR contract so you have some assurance or protection if the EHR vendor can’t deliver on their sales promises. Not to mention, after the EHR implementation you have a way to measure if it was a success or not based upon those goals.

Test the WIIFM principle. Not from an arrogant Me Me Me approach. Instead, step into the other people’s shoes and ask WIIFM. This approach can really help improve any EHR Implementation if applied correctly.

I’ve had some interesting reactions to my post about the various characteristics of a Jabba the Hutt EHR Vendor. One of the more interesting conversations happened by email with a reader named Richard. Yes, I have lots of interesting back channel discussions.

After a lengthy email exchange, I asked Richard if I could post our discussion on the blog so you could participate as well. He agreed and even commented, “I look forward to an expansion of our discussion.” So, here you go (or at least scroll to the bottom for a short summary of my feelings).

The conversation started with this email that Richard sent me:

I understand your reluctance to name names in your article, BUT… this is exactly what is needed.

I’ve taken a few days to ruminate over what I was going to suggest and I’d like to hear your thoughts on this if you have time.

With your readership, I suspect there are plenty of users and observers of current packages and lots of opinions. Why not set up something like a Wiki-EMR site to provide a resource that will allow everyone to provide input into the details making “Jabba” and “Han Solo” EMR systems and see where it goes? Maybe it could eliminate some of the BS surrounding some of these systems and help others who are trying to sort out there own future needs. I’m sure there are plenty of people out there who want, need and are willing to provide information on the state and future of EMR and what is BS and what isn’t. I certainly would. Let me know your (or your readers) thoughts.

Richard

Here was my response:

Hi Richard,
Yes, this is something I’ve thought a lot about. The key question for me is how to publish some sort of “authenticated” information. Most systems are so easily gamed and/or abused that they basically have no worth. I haven’t figured out a scalable way to be able to provide information that is actual data and not provided with undue influence.

As I read your email, I wondered if some sort of combination of LinkedIn might be the key. At least then any review that’s done would be tied to an individual. Although, by doing so, you’d then discourage many of the most interesting reviews and feedback because their name would be explicitly tied to the review.

Along these same lines I’ve wondered how I could provide a “Meaningful EHR Certification” that wasn’t based on a pass/fail system that has no value. Instead it was a mixture of qualitative and quantitative data that would actually be of value to the reader. Scaling that up is the challenge I have with that idea. Not to mention figuring out the right financial model for it.

So, as you can see I’m with you on wanting more specific information out there, but not sure how to overcome the abuse and the scale that you need for it to be valuable.

As a side note, I do have a wiki page: http://emrandhipaa.com/wiki/Main_Page and it even has an EMR and EHR Matrix of companies. Although I closed registrations since spammers were getting into it.

Richard then provided this response:

It seems to me that user editing must be do-able if Wikipedia has found a way. Additionally, I think that unvarnished truth through comments creditable or not (but differentiateable ) would be a place for insiders or knowledgeable users and IT pros to vent. I realize that it is open to abuse, but a user moderated (or whatever Wikipedia uses) forum will turn upon such miscreants and their abuse might well backfire. I realize it is quite a project, but I’ll bet there are a handful of your readers, if not many more, that would gladly help put something this critical in place. If this can be pulled off, it might create “the world’s foremost authority” * in EMR.

I don’t know much at all about this, but I have a feeling that so much is riding on all of this and that there is a vacuum of useful, meaningful and understandable information that is needed to make this whole thing work. I know there must be something prescient sounding I could offer here, but it might be just indigestion that’s giving me this feeling. John, there must be some other smart guys around; try to round up some and see what they think.

Then I offered this response which shows I’ve been on Wikipedia far too much:

I’ve been rolling around something like this since I first started blogging about EMR. Wikipedia’s a bad comparison because it tries to formulate 1 truth instead of a series of opinions about something. Plus, Wikipedia relies on the masses of people (we don’t have enough mass) and even they get to a point where they regularly lock pages after abuse happens. Wikipedia’s a crazy community once you get into it. There are flame wars and battles on Wikipedia that rage in the background that most people don’t realize are happening.

Travel and hotel sites are a better comparison actually. Since reviews of hotels are more similar to a review of an EMR. The hotel owner wants to put the best reviews on there and can plant good reviews amongst many other ways to game the ratings and review systems. I read an interesting story about how Trip Advisor tried to deal with this. Unfortunately, it put on the image of successfully battling it, but didn’t do that well. Matters much less when you’re talking about a hotel versus an EMR.

I agree that it could become the authority on EMR software if it’s done right. Although, for me to do it, I have to find a model that’s authentic, honest, reliable, scalable and that makes sense economically. At least until I sell off a company for a few million. Then, maybe I can cut out the economical requirement.

Then Richard commented:

I didn’t realize that abuse was that rampant and that a fix was so difficult. I think I see some of the problems. You almost need a cadre of “fair witnesses” to explore the opinions and observations of users and provide incorruptible analysis. Not a promising outlook.

I’d be happy to assist this enterprise in any way I can, but don’t think I would bring anything very useful to the table. I feel you may be the right person to bring something like this to fruition, but the resources needed may be out of reach. It’s too bad there isn’t a Consumer Reports -like group out there for something like this. Maybe some group has enough vested in the outcome of shake-out to fund independent assessment and provide a forum for users.

I know very little about the technology involved in EMR, I am more aware of the medical business and needs for improvement in record and information management. Additionally, if cost containment can’t be managed and a “best practices” can’t be incorporated into every patient’s care then our society may be doomed economically (even morally). You’re doing something valuable, so keep it up, there must be a way to sort out the players and the technology so we can get on with the real need which is getting something useful and beneficial installed for quality patient care. Even getting this discussion broadened is worthwhile.

Well, there you go. If you made it through that, then you must really care about EHR and healthcare IT like I do.

In summary, I think it’s quite clear that it’s an incredible challenge for those searching for EHR software to find reliable information. The need for good EHR vendor information is extraordinary and no one has cornered that market…yet? There is no “consumer reports” for EHR software.

I haven’t yet identified a model that’s authentic, honest, reliable, scalable and that makes sense economically to deliver said “consumer reports for EHR software.” (or maybe I’m just too lazy, scared, busy, etc to try)

I do think that this site and the other members of the Healthcare Scene blog network provide a valuable independent resource for those selecting and implementing an EMR. My free EHR selection e-book was one effort to help providers in the EHR selection process in a very targeted way.

Are there other things that I (we) could do to help even more? I’m sure. If you have ideas, I’m interested to hear. You see my off the top of my head criteria above.

If nothing else, we can reach Richard’s goal of “broadening the discussion”

This is the second in a series of EMR and EHR interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. Muir can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our http://www.emrandehr.com/contact-us/“>Contact Us page.

Dr. Peter Muir of Springfield Center for Family Medicine was interviewed recently concerning his acquisition of the maximum Medicare Incentive for showing Meaningful Use of a Certified EHR. The Ohio based primary care practice has been using NextGen Ambulatory since 2003 and NextGen Management since 2006.

Dr. Muir stated that their practice chose NextGen EHR because the company focused on clinical offices. Dr. Muir and NextGen EHR share the philosophy of always searching for ways to improve the product. Dr. Muir not only believes in this philosophy but also attended a development think tank along these lines at NextGen’s headquarters. He was also drawn to NextGen because he wanted the capability of customizing his templates.

Having demographics, scheduling, clinical and billing information all on one database has had a huge impact on Muir’s practice. He feels that having a centralized database “makes reporting much easier and more comprehensive than those EHRs with separate databases or separate vendors”. The doctor admitted the conversion from paper charts to EHR was stressful for the first year but well worth it in the long run.

Since Muir’s office has been using EHRs (since 2003), there have been relatively few changes needed for Meaningful Use and any required upgrades to the system came as part of the standard NextGen maintenance fees. There was data that had to be added which was not normally collected by his practice as it had little relevance to his patients but from the patients’ perspective, there was no change in the attention patients received from Springfield Center.

The family practitioner Muir credits the CMS web site and NextGen Healthcare for not only the upgrades to their EHR software but also for their pathway documents and webinars which helped them show meaningful use. He also credits GBS of Youngstown, Ohio (his NextGen vendor for hardware, software) who also helped them implement security upgrades in 2010 in anticipation of the process.

Additionally, being a part of the ONC Meaningful Use Vanguard Program was a benefit to Dr. Muir because “it provides recognition which may allow a greater input in system design and operation.” Muir is concerned, though, that the Program’s flow of information may be difficult if multiple database silos remain in service and a lack of standardization isn’t addressed.

Especially with respect to Meaningful Use Stages 2 and 3, the doctor believes it is critical to have professional health providers utilizing some form of regional system – versus individual systems – in order to have a seamless flow of information. Muir has begun such a system within his own state of Ohio.

The doctor was intricately involved in starting CCHIE (Collaborating Communities Health Information Exchange) in Springfield, Ohio. CCHIE chose HealthBridge as their data engine and together they have partnered with other healthcare providers to provide electronic access to patients’ lab and radiology results as well as to admissions, discharges and transfer information. They have added regions in Southern Indiana and two regions in Northern Kentucky.

Dr. Muir’s advice to fellow doctors is that unless they are planning to retire within the next couple of years they should not delay in the implementation of an EHR. The longer they wait, the more difficult and time consuming the transition will be because, with time, the activities of daily practice will be much broader and more demanding. Additionally, he suggests providers select a system that does not just meet Meaningful Use requirements. His advice is to “select a system that assists you in providing better medical care”.

Read the full transcript of Dr. Muir’s interview.

One of my favorite EMR people, Matt Chase from Medtuity, wrote this interesting comment over on EMR Update.

Times are achanging. I think a recent install is a good example. The group purchased a decently well-known EMR and it failed. So they went with a second well-known EMR and it failed. Both were certified. Both had a very active sales team. The second one flew in some upper level sales people from the coast when there was talk of deinstall.

After spending half of the national debt and a looming closure of the practice, they called in a consultant. He made his recommendation. They did their demo and they asked the really hard questions– show me how to create new clinical content, show me how to create a new template, edit an existing one, how to fax a single encounter to another practitioner, then multiple encounters but not all encounters of a patient, track any lab value over time, send a reminder to a staff member, assign faxes and scans, etc, etc. Their list was very long. They did not want to hear promises and they did not want a canned demo. They wanted to see the software perform the steps that were lacking (but promised present) in their previous software.

The underlying theme here is that practices believe that certification is truly a functional seal of approval. It is not. Secondly, because certification exists and so many EMRs (>450) are certified, it implies a mature product offering– like buying a hard drive or a computer. You can expect certain functionality to be present simply because the maturity of the market would have eliminated the company. Unfortunately, just the opposite is true.
…
Just this week I learned that a very large practice in our town is out shopping another EMR. Yes, they have a certified one, but they certainly aren’t paperless.

Functionality will become the watchword of EMR, not certification.

That’s some interesting projections. I remember one EMR vendor telling me that a large portion of their sales were to existing EMR users. In fact, I think they said that there favorite implementations were existing users that were switching to their EMR. I also love the observation of how much better an organization is at selecting an EMR the second time they do it.